| NPI | 1225572969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IN 33007826A) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IN 33007826A) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 33007826A) | |
| 101YM0800X Counselor, Mental Health (Licence: IN 33007826A) | |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2016-12-15 |